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Detection of bulimia in a primary care setting

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Abstract

Objective: To develop a screening tool for the identification of bulimia in ambulatory practice.

Design: Administration of a 112-item questionnaire about eating and weight-control practices to women with known bulimia and to healthy control patients. Questions were compared with DSM-III-R criteria of bulimia as a “gold standard.”

Setting: Self-help group for eating disorders and hospital-based primary care practice.

Subjects: Thirty of 42 women with known bulimia met DSM-III-R criteria for current bulimia, and 124 of 130 control patients met the criterion of no history of an eating disorder.

Main results: Thirteen individual questions discriminated between bulimic subjects and control subjects with a sensitivity and specificity of >75%. When these questions were entered into a stepwise logistic model, two questions were independently significant. A “no” response to the question “Are you satisfied with your eating patterns?” or a “yes” response to “Do you ever eat in secret?” had a sensitivity of 1.00 and a specificity of 0.90 for bulimia. The positive predictive value, based on a 5% prevalence, was 0.36.

Conclusions: A set of two questions may be as effective as a more extensive questionnaire in identifying women with eating disorders, and could be easily incorporated into the routine medical history obtained from all women.

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References

  1. Drewnowski A, Hopkins SA, Kessler RC. The prevalence of bulimia nervosa in the US college student population. Am J Public Health. 1988;78:1322–5.

    PubMed  CAS  Google Scholar 

  2. Connors ME, Johnson CL. Epidemiology of bulimia and bulimic behaviors. Addict Behav. 1987;12:165–79.

    Article  PubMed  CAS  Google Scholar 

  3. Thelen MH, Mann LM, Pruitt J, Smith M. Bulimia: prevalence and component factors in college women. J Psychosom Res. 1987;31:73–8.

    Article  PubMed  CAS  Google Scholar 

  4. Cooper PJ, Fairburn CG. Binge-eating and self-induced vomiting in the community. A preliminary study. Br J Psychiatry. 1983;142:139–44.

    PubMed  CAS  Google Scholar 

  5. Hart KJ, Ollendick TH. Prevalence of bulimia in working and university women. Am J Psychiatry. 1985;142:851–4.

    PubMed  CAS  Google Scholar 

  6. Zuckerman DM, Colby A, Ware NC, Lazerson JS. The prevalence of bulimia among college students. Am J Public Health. 1986;76:1135–7.

    PubMed  CAS  Google Scholar 

  7. Pope HG Jr, Hudson JI, Yurgelun-Todd D, Hudson MS. Prevalence of anorexia nervosa and bulimia in three student populations. Int J Eat Dis. 1984;3:45–51.

    Google Scholar 

  8. Zinkand H, Cadoret RJ, Widmer RB. Incidence and detection of bulimia in a family practice population. J Fam Pract. 1984;18:555–60.

    PubMed  CAS  Google Scholar 

  9. Herzog DB, Norman DK, Rigotti NA, Pepose M. Frequency of bulimic behaviors and associated social maladjustment in female graduate students. J Psychiatr Res. 1986;20:355–61.

    Article  PubMed  CAS  Google Scholar 

  10. Herzog DB, Copeland PM. Eating disorders. N Engl J Med. 1985;313:295–303.

    Article  PubMed  CAS  Google Scholar 

  11. Mitchell JE, Seim HC, Colon E, Pomeroy C. Medical complications and medical management of bulimia. Ann Intern Med. 1987;107:71–7.

    PubMed  CAS  Google Scholar 

  12. Mira M, Stewart PM, Vizzard J, Abraham S. Biochemical abnormalities in anorexia nervosa and bulimia. Ann Clin Biochem. 1987;24:29–35.

    PubMed  CAS  Google Scholar 

  13. Winstead DK, Willard SG. Bulimia: diagnostic clues. South Med J. 1983;76:313–5.

    PubMed  CAS  Google Scholar 

  14. Henderson M, Freeman CPL. A self-rating scale for bulimia. The “BITE”. Br J Psychiatry. 1987;150:18–24.

    Article  PubMed  CAS  Google Scholar 

  15. Schulman RG, Kinder BN, Powers PS, Prange M, Gleghorn A. The development of a scale to measure cognitive distortions in bulimia. J Pers Assess. 1986;50:630–9.

    Article  PubMed  CAS  Google Scholar 

  16. Smith MC, Thelen MH. Development and validation of a test for bulimia. J Consult Clin Psychol. 1984;52:863–72.

    Article  PubMed  CAS  Google Scholar 

  17. Garner DM, Olmstead MA, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Dis. 1983;2:15–34.

    Google Scholar 

  18. Garner DM, Olmsted YB, Bohry Y, Garfinkel PE. The Eating Attitudes Test: psychometric features and clinical correlates. Psychol Med. 1982;12:871–8.

    PubMed  CAS  Google Scholar 

  19. Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med. 1979;9:273–9.

    Article  PubMed  CAS  Google Scholar 

  20. Hawkins RC II, Clement PF. Development and construct validation of a self-report measure of binge eating tendencies. Addict Behav. 1980;5:219–26.

    Article  PubMed  Google Scholar 

  21. Pope HG, Hudson JI, Yurgelun-Todd D. Anorexia nervosa and bulimia among 300 suburban women shoppers. Am J Psychiatry. 1984;141:292–4.

    PubMed  Google Scholar 

  22. Hudson JI, Pope HG. Eating Habits Questionnaire. 1988 (unpublished manuscript).

  23. Halmi KA, Falk JR, Schwartz E. Binge-eating and vomiting: a survey of a college population. Psychol Med. 1981;11:697–706.

    Article  PubMed  CAS  Google Scholar 

  24. Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252:1905–7.

    Article  PubMed  CAS  Google Scholar 

  25. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, third edition, revised (DSM-III-R). Washington, DC: APA, 1987.

    Google Scholar 

  26. Pyle RL, Halvorson PA, Neuman PA, Mitchell JE. The increasing prevalence of bulimia in freshman college students. Int J Eat Dis. 1986;5:631–47.

    Google Scholar 

  27. Katzman MA, Wolchik SA, Braver SL. The prevalence of frequent binge eating and bulimia in a nonclinical college sample. Int J Eat Dis. 1984;3:53–62.

    Google Scholar 

  28. Mitchell JE, Hatsukami D, Eckert ED, Pyle RL. Characteristics of 275 patients with bulimia. Am J Psychiatry. 1985;142:482–5.

    PubMed  CAS  Google Scholar 

  29. Fairburn CG, Cooper PJ. Self-induced vomiting and bulimia nervosa: an undetected problem. BMJ. 1982;284;1153–5.

    Article  PubMed  CAS  Google Scholar 

  30. Goldberg RJ. Depression in primary care: DSM-III diagnoses and other depressive syndromes. J Gen Intern Med. 1988;3:491–7.

    Article  PubMed  CAS  Google Scholar 

  31. Herzog T, Drinkmann A. Psychotherapy of bulimia nervosa: what is effective? A meta-analysis. J Psychosom Res. 1992;36:159–67.

    Article  PubMed  Google Scholar 

  32. Mitchell JE. A review of the controlled trials of psychotherapy for anorexia and bulimia nervosa. J Psychosom Res. 1992;35(suppl 1):23–31.

    Google Scholar 

  33. Pyle RL, Mitchell JE, Eckert ED, Hatsukami D, Pomeroy C, Zimmerman R. Maintenance treatment and 6-month outcome for bulimic patients who respond to initial treatment. Am J Psychiatry. 1990;147:871–5.

    PubMed  CAS  Google Scholar 

  34. Bingham RL, Plante DA, Bronson DL, Tufo HM, McKnight K. Establishing a quality improvement process for identification of psychosocial problems in a primary care practice. J Gen Intern Med. 1990;5:342–6.

    PubMed  CAS  Google Scholar 

  35. Coulehan JL, Schulberg HC, Block MR. The efficiency of depression questionnaires for case finding in primary medical care. J Gen Intern Med. 1989;4:541–7.

    Article  PubMed  CAS  Google Scholar 

  36. Cyr MG, Wartman S. The effectiveness of routine screening questions in the detection of alcoholism. JAMA. 1988;259:51–4.

    Article  PubMed  CAS  Google Scholar 

  37. Schotte DE, Stunkard A. Bulimia vs. bulimic behaviors on a college campus. JAMA. 1987;258:1213–5.

    Article  PubMed  CAS  Google Scholar 

  38. Szmukler GI. The epidemiology of anorexia nervosa and bulimia. J Psychiatr Res. 1985;19:143–53.

    Article  PubMed  CAS  Google Scholar 

  39. Inui TS, Jared RA, Carter WB, et al. Effects of a self-administered health history on new-patient visits in a general medical clinic. Med Care. 1979;18:1221–8.

    Article  Google Scholar 

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Author notes

  1. Linda G. Lesky MD

    Present address: the Division of Clinical Epidemiology and the Division of General Medicine and Primary Care, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts

Authors and Affiliations

  1. the Women’s Health Unit, University Hospital, Boston University Medical Center, Boston, Massachusetts

    Karen M. Freund MD, MPH & Linda G. Lesky MD

  2. the Section of General Internal Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston University Medical Center, Boston, Massachusetts

    Karen M. Freund MD, MPH, Susan M. Graham MPH, Linda G. Lesky MD & Mark A. Moskowitz MD

Authors
  1. Karen M. Freund MD, MPH
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  2. Susan M. Graham MPH
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  3. Linda G. Lesky MD
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  4. Mark A. Moskowitz MD
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Additional information

Supported by Training Grant F32 HS 00027-01 from the National Center for Health Services Research (now Agency for Health Care Policy Research), and in part by the National Institute of Health Biomedical Research Support Grant #S07-RR05487-28.

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Freund, K.M., Graham, S.M., Lesky, L.G. et al. Detection of bulimia in a primary care setting. J Gen Intern Med 8, 236–242 (1993). https://doi.org/10.1007/BF02600088

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